221-223 WASHINGTON STREET - SIGN PERMIT 221-223 WASHINGTON STREET
METRO PCS
231-251 WASHINGTON STREET 563-09
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
GIS#: 821
Map: 34 l
Blo
Lot: 040G
Lot: SIGN PERMIT
Li
Pemlit: Sign
Category: SIGN {
Permit#_ 1563-09 =� PERMISSION IS HEREBY GRANTED TO:
Project# JS-2009-001056_
Est.Cost:_ $0.00 Contractor: License: Expires
Charged:
Fee $20.00 AMERSIGN
Balance Due:$.00 Owner. RCG 90 LAFAYETTE LLC
#of Fixtures Applicant.• RCG 90 LAFAYETTE LLC
DigSafe# _ !AT. 231-251 WASHINGTON STREET
UseGroup
ConstClass
ISSUED ON. 18-Feb-2009 AMENDED ON. EXPIRES ON. 18-Aug-2009
TO PERFORM THE FOLLOWING WORK.
ERECT SIGN FOR METRO PCS
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPC'VIOLATION OF'AAN eOF
ITS RULES AND REGULATIONS. O 2,
Signature: d
Fee Type: Reeelpt No: Date Paid: Check No: Amount:
SIGN REC-2009-001218 18-176-09 38 520.00
Gni r%is k 2009 Drs I.uuriers\lu nicipal Solutions.lite.
{
City of Salem Sign Permit Application Worksheet
21-Jan-09
MetroPCS
221 Washington St
Zoning(res/non-res) C5
Entrance Corridor(YIN) N
Lot frontage 61 feet
Building or tenant frontage 61 feet
#of businesses on site 1
Bldng dist from street center 135 feet
Multiplier 1.25
Building and Blade Signs
maximum area permitted 76.25 sq ft
total proposed sign area -W.r3sq ft `4
sign 1
length 150.00 inches
height 34.00 inches
sign 2
length 1 ches i
hei 34.00 inches n--f O�
sign 3 v4_
length 0.00 inches
height 0.00 inches
sign 4
length 0.00 inches
height 0.00 inches
sign 5
length 0.00 inches
height 0.00 inches
Freestanding Signs
maximum area permitted 0.00 sq ft(per side)
maximum#of signs permitted 0 signs
maximum height permitted 0.00 It tall
sign 1
proposed sign area 0.00 sq it
length 0.00 inches
height 0.00 inches
proposed sign height 0.00 ft
sign 2
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height ft
Application meets guidelines set
forth in the Salem Sign Ordinance yes
Recommend approval yes
J9 09'08a American Sign 17818267256 p.8
Permlt Number
APPLICATION FOR PERMIT TO ERECT A SIGN
�i3 Sjil NOTE:BUILDING PERMT MUST BE OBTAINED BEFORE SIGN IS ERECTED
Location, Ownership and Detail Must Be Correct, Complete,and Legible
s s
Salem, Massachusetts
Date
To the Building Inspector: /
The undersigned hereby applies for a permit to ❑Alter. ❑Repair a sign on the following described buildings.
Street Address Zoning District
W 6'Tb S T o Urban Renewal Area ❑Entrance Corridor
❑Historic District ❑ None
.4Q--XA1U12C1Z, SCqolp
Telephone _ 7 CI _ Q 0o 6 1 floor RETA2�
rqA ,-
�- s floor
Address -+ , �- 3 floor
otj
Telephone 6_ _ as 3 4 floor
E-mai 0-eltuicri How many businesses are in the buiding?
If
a corporate body, name
of responsible officer NVV%E S PAC
C S - e3tj TLC- Ii.. Bunlding linear feet
Cmstruction Sups license No IG4(" Exp 11_4-0 9-G-1Y-1Y Applicant's Space Cif mWC-tenant)Zy linearfeet
Address uG - 7- - Property linear feet
Telephone U L3,;5 — -4 r)5- s–dao
Email I MCS S' l6 K1. tM ❑ Owner 'gn Erector a Other
S nt Si n2 r6l Sign 3
urface po6urface o Surface
n Right Angle to Building in Right Angle to Building ❑Right Angle to Building
o Free Standing o Free Standing o Free Standing
a Awning a Awning ❑Awning
a Other(specify) o Other(specify) ❑Other(specify)
Sign Materials Sign Materials Sign Materials
Sign Dimernsiarts Sign Dimers Sign Dimensions
150 X d " 7 ��y
Sign Area aa S F T Sign Area Sign Area
OF s ft sq It
Sign Height(if Iree standing) Si Heght(if free standing) Sign Height(f free standing)
Estimated Cost of Net Work
$ 0Q
Type Sign Area To Be Removed? Sign Owner
o Surface sq ft a yes o no
a Right Angle to Building sq tt a yes o no
o Free Standing sq ft a yes ❑no I Wn Owners Autbor rive
o Awning sq ft o yes o no
❑Other(specify) sq ft o yes o no
Property Owner
-
n
Planning&Community Development Department Historical Commission
Building Inspector
�iNIgB rev
Metro PCS-PCS Partners-221 Washington St. Salem, MA
22 Sq ft of graphics 150"
34" MetrOPCS
Authorized Dealer
Front View Side View
1 New 1"Deep Pan Sign
w/Mounted 1"3-D Non-Illuminated Letters
A 40
Ilk
Landiwd Apprwal Signature:
7'lew�etnel ❑roar
❑Mwwm nn ream
wroxnn ❑raMpwm+�.axum
Metro PCS- PCS Partners-221 Washington St. Salem,MA
Scale: 1/8'' = 1 '
193"Storefront 174"Storefront 363"Storefront I
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Landimd Approval SlgnaWn:
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Metro PCS-PCS Partners-221 Washington St. Salem,MA
Survey Photos
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co Mum PCS-PCS Partners-211 Washington St, Salcm,MA
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Jan 20 09 09:07a American Sign 17818267256 p.1
City of Salem
Department of planning and Community Development
Art Tom Daniel, AICP
Economic Development Manager
Hi Tom,
I was in your office Friday morning trying to get on the schedule for January 28, 2009
For the Design Review Board,I talked to a person in there they told me to send you every
thing,And ask you if I could get on the schedule, I have enclosed all that I think you
need,Except my Cert of Insurance my broker is close today but will have them fax it to
you,the owner of the building is on the 2cd floor of your building and said he would sign
the permit application, His name is Alexander Schnip#202-A.
Thank you
W�O
James S Butler
Amersign
800-535-0308
16 Dwelley St
Pembroke, MA 02359-1719
Jan 20 09 09:07a American Sign 17818267256 p.2
Saternm
d )) 11 yy}�
Design Review Board
Meeting Schedule, 2009
Unless otherwise noted, all meetings of the Design Review Board (DRB) are held on the fourth
Wednesday of each month at 6:00pm in the Third Floor Conference Room at 120 Washington
Street. All submittals are due by 12:00 noon on the submittal deadline date shown.
Meeting Date Submittal Deadline
January 28, 2009 January 16, 2009
February 25, 2009 February 13, 2009
March 25, 2009 March 13, 2009
April 22, 2009 April 10, 2009
May 27, 2009 May 15, 2009
June 24, 2009 June 12, 2009
July 22, 2009 July 10, 2009
September 23, 2009 September 11, 2009
October 28, 2009 October 16, 2009
November 18, 2009` November 6, 2009
December 16, 2009' December 4, 2009
*Date for the November and December meetings are being held on different nights than
normally scheduled due to the holidays.
Jan 20 09 09:07a American Sign 1 781 826 7256 p.3
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dna
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name (Bnsmessrorganiationllndividvai):_ A)
Address:_/L -S 7-
City/State/Zip:
City/State/Zip: O-Q f F Phone #:
An you an employer?Check the appropriate boa: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New jest(required):
—y�kryees(AM and/or part-time).' have hired 81e sub-mnrracron
construction
2. i I am a sole proprietor or partner- listed on the attached sheet t 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers'comp. insurance. 9. ❑Building addition
(No workers' comp. insurance 5. [1 We are a corporation and its
required.] officers have exercised their I0.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right ofexcmption per MGL 11.❑ Plumbing repairs or additions
myself[No workers' cornp. c 152,§I(4), and we have no 12❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ other Sl fo(V�'
comp.insurance required.]
'AMY applicam thatebeds boa#1 moa also IDI sot the a cbm below showing thew wotlta'eompmmtoa policy iafiotmatoa
t Homaownen wbo mb--t fors atfdsvit iadicaRog they ate doing all work sad then lure maside euevacton tmst tobant a new affi&�t in&c ming soeh
tr-'- ff-etoa that ebwk ibis box amet etuebad ae additional sheet Acmiog the tame ortbe suboononcem sad thea wortcra
tamp.policy iarontttapon.
I mn art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie. M. Expiration Date:
Job Site Address: CitylState/Zfp:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and Miration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or ono-year imprisonment, as won as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ' under the pains and penalties of perjury that the information provided above is true and correct
Si ate:
Phone /— c4Oo —J 3-S o 3 6 e5
Official use only. Do not wrke In this arra,to be completed by city or town official
City or Town: Permlt/Lieense#
Issuing Authority(circle one):
1.Board of Health Z.Building Department 3.Chyrlown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
Mctm PCS-PCS Parham-221 fthingtmt St Salem•MA
.22S31101Ofa0flieS 150" 122 S0 Itulufaullies iso" I
34 MetroP 34" metroPCS
�„�
� Authorized Dealer
N
Front View Side View fmnl View �� Side View
2 New 1"Deep Pm Signs
wJ Mounted 1-3-0 Non-Illuminated Leiters
pa�lyy��,
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Metro I'CS•PCS PaMcrs-221 Washington St.Salem,MA
Scale: 1/8" = 1'
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Jan 20 09 09:08a American Sign 17818267256 p.7
CITY, OF BOSTON .. _.
BOARD OF EXAMINERS
.NA YOR P
JAMES S BflTLER
..
: .. 6-7A613 -c r !il1101
I I
BOARD CF Ey4!,^i==5 Cs.....i�1Y�a.14.....
Shue C.( Ey . 7
v j� hlf� � j /19•� 6�; 3S
01/20/2009 03 : 18PM FAXCOM PAGE 2 OF 3
ACORD CERTIFICATE OF LIABILITY INSURANCE 1/20/2009
PRODUCER (617)964-5340 FAX: (617)965-1843 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Marketing Associates Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
150 Wells Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Newton MA 02459 INSURERS AFFORDING COVERAGE NAICA'
INSURED INSURMAKartford Fire Insurance 19682
AMERSIGN INSURER B:
16 DWELLEY STREET INSURER G.
IN R D
PEMBROKE MA 02359 INSURERS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIFS DESCRIBED HEREIN IS SURIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
INSfl ADOT POLICY EFFECTIVE POLICY EXPIRATION
TYPEOFINSURANCE POLICY NUMBER DATE TEM LIMITS
G ENERAL UABI LITV OCCURRMCE 1,000,00
z COMMEFI W GENERA-UABIUTY DAMAGE TO RENTED F ;00,00
A GLAa1SMADE CCIXIq 08EBMVH1518 1/1/2009 1/1/2010 MEDE(P aw NPR $ 10,00
1,000,00
2,000,00
GENL AGGREGATE LIMIT APPLIES PER. 6gg2,000,00
E
AUTOMOBILE UABILITY CONIBNED SINGLE UNIT
ANYAlTO (E.WYINDN) S
KL OWNED AUTOS BODILY NIURY
SCHEDULEDAUTOS (Pa,P—) P
HIS EDAUTOS BODILY INJURY
NON OWNED/WTOS (Pw �") E
PROPERTY DAMAGE F
(Pe.FmeN)
GARAGE LIABILITY AUTOONLY,EAA.CCIDENT $
ANY AUTO OTHER THAN
PLTOONLY. AGO
EXCESSA/MBRELLA LIABILITY
OCCUR LICLAIMS MADE
DEOUCTIBLL
RETENTION
WORKERSCOMPENSATIONAND RCSTATU OTH
EMPLOYERS'LIABILITY i TORY 11MITS FR
ANYPROPRIETCR,PARTNEVEXECUTIVE EL EACH ACCIDENT
CFFICERAIEMBER D(CLUDEM
IT Ye.,A.enDo aper
OTHER
DESCRIPTIONOFOPEMA NSILOCARONSNEHICLES!EXCLUSIONSADDEDBYENOOMEMEMSPECIALPRONSIONS
CERTIFICATE HOLDER CANCELLATION
(978)740-0404 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of Salem EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Attn: Tom Daniel, AICP 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
93 MA01970 gt OR Street
Salem,em,Washington
MA FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER US AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Michael Su6co/JESSIE
ACORD 25(2001/08) .0 ACORD CORPORATION 1886
INS025(0108)o Fag.1 N 2
01/20/2009 03 : 18PM FAXCOM PAGE 3 OF 3
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an
endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001/08)
INS025(oiw).m Pepe 2 02
City of Salem Department of Planning & Community Development
Check/Cash Receipt and Tracking Form
Please complete form and make two copies.
Date Received r IMES
r �
Amount Received
Form of Payment Check ❑ Cash
Client Information
CASH PAYMENTS: client initials
Sign Permit Application Fee
❑ Conservation Commission Fee
Payment received for what ❑ Planning Board Fee /ZBA
service? ❑ SRA/DRB Fee
❑ Old Town Hall Rental Fee
❑ Other:
Name of staff person receiving
payment
Additional Notes �tl cc
AMERSIGN EXPLANATION 3 Q ;
OPERATING ACCOUNT AMOUNT lJ
16 OWELLEY ST.
PEMBROKE,MA 02359-1719 5.7017/211
PH. 781-a26-7288 - 16
PAY
AMOUNT
OF c�
DATE v DOLLARS 8
TOT E ORDER OF „...
DESCRIPTION ex[a
xw�am
EMU PC,S $ o?
CRIZZMt MANX
MASSACHUSETTS ♦w . I\`\l1
AI!lMpFitED ani'aiUUE
11100383911' 1: 2110701951: 130S09282911'
Original Check and Form: DPCD Finance
Copy 1: Client
Copy 2: Application File
a� Salem
Redevelopment
�1.t.lt�!C1T1tZ�
Salem Redevelopment Authority Decision
February 11, 2009
221 Washington Street (metroPCS): Discussion and vote on proposed signage
SRA Decision
At their meeting on February 11, 2009, the SRA voted to approve the February 4,
2009 DRB recommendation for the proposed signage at 221 Washington Street.
DRB Recommendation
At their meeting on February 4, 2009, the DRB voted to recommend approval of
the proposed signage at 221 Washington Street with the following conditions:
- the blue colored panels shall be installed across all three storefronts at the
same elevation and be 34" high;
- there shall only be one sign and it shall be located above the main
entrance;
- the sign lettering shall be raised off the panel; and
- the applicant will need to submit a new sign permit application if they
decide to add window lettering.
Staff Comment
The sign erector attended the DRB meeting and did not have final authority to
agree to the conditions in the DRB's recommendation. The business
subsequently modified the proposal to include only one sign above the center
entrance. This is the version submitted for SRA approval. The SRA could choose
to accept the revised design, or refer it back to the DRB.
Original Proposal Submitted to DRB
The proposal consists of two wall signs. Each sign is 150" by 34" and consists of
raised white letters on a blue aluminum pan. The signs' square footage complies
with City and SRA guidelines.
aduz-50
.aim
Installations & Fabrication
800-535 -0308
jim@amersign.com
James S Butler, 16 Dwelley St., Pembroke, MA 02359
City of Salem EC E� t
Department of planning and Community Development JAN 2 3 2009
Att Tom Daniel, AICP aP1.of FLAWMG &
Economic Development Manager C
Hi Tom,
I was in your office Friday morning trying to get on the schedule for January 28, 2009
For the Design Review Board, I talked to a person in there they told me to send you every
thing, And ask you if I could get on the schedule,I have enclosed all that I think you
need, Except my Cert of Insurance my broker is close today but will have them fax it to
you,the owner of the building is on the 2cd floor of your building and said he would sign
the permit application, His name is Alexander Schnip# 202-A.
Thank you
James S Butler
Amersign
800-535-0308
16 Dwelley St
Pembroke, MA 02359-1719
Salem
Redevelopment
Authority
Design Review Board
Meeting Schedule, 2009
Unless otherwise noted, all meetings of the Design Review Board (DRB) are held on the fourth
Wednesday of each month at 6:00pm in the Third Floor Conference Room at 120 Washington
Street. All submittals are due by 12:00 noon on the submittal deadline date shown.
Meeting Date Submittal Deadline
January 28, 2009 January 16, 2009
February 25, 2009 February 13, 2009
March 25, 2009 March 13, 2009
April 22, 2009 April 10, 2009
May 27, 2009 May 15, 2009
June 24, 2009 June 12, 2009
July 22, 2009 July 10, 2009
September 23, 2009 September 11, 2009
October 28, 2009 October 16, 2009
November 18, 2009* November 6, 2009
December 16, 2009* December 4, 2009
*Date for the November and December meetings are being held on different nights than
normally scheduled due to the holidays.
Department of Industrial Accidents
Office of Investigations
600 Washington Street
r' Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information n Please Print Legibly
Name (Businessorganization/individual): /•tbyzr S°!6/)
Address: f L U Y S T
City/State/Zip:� C123SE Phone#:
Are you an employer? Check the appropriate boa: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
mp
7 loyees(full and/or part-time).* have hired the sub-contractors
2. I am a sole proprietor or partner- listed on the attached sheet ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in an capacity. workers'comp.insurance
Y P tY• 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.] officers have exercised their
3. ❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers
comp. insurance required.] 13.[:] OtherSI
•Amy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information'
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractots that check this box must attached an additional shat showing the meme of the sub-contractors and their workers'comp,policy infozrnation.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lia M Expiration Date:
Job Site Address: City/Statwzip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in'the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby m;fy under the pains and penalties of perjury that the information provided above is true and correct
Si attae: Date: 1-19-0?
Phone /'— 8'Oo — -) 3 S O 3 e5
Official use only. Do not write in this area,to be completed by city or town offreiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Metro PCS-PCS Partners-221 Washington St.Salem,MA
22 Sq ft of graphics 150" 22 Sq It of graphics 150'
34" metropcs34' �, • r
DealermetroPCS
Authorized
Front View � Side View Front View �� Side View
A lJu{ J
2 New 1"Deep Pan Signs
w/Mounted 1"3-D Non-Illuminated Letters
�T
metiroPCS
metrol
V 7-
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■ .:.elcrl Apgovel Sprelve
—
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Metro PCS-PCS Partners-221 Washington St.Salem,MA
Scale: 1/8" = 1'
193"Storefront 1 174"Storefront - 363"Storefront J
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CITY OF BOSTON
BOARD OF EXAMINERS
MAYOP.Ax
JAMES S BUTLER
G-14 G-15 (H�9108
I
BOARD IF EX AVINE?S
s
(o ,g w 6 L.L. Q - 7T
?fes eioeE 10
Permit Number
APPLICATION FOR PERMIT TO ERECT A SIGN
NOTE:BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED
Location, Ownership and Detail Must Be Correct, Complete, and Legible
�4 Salem, Massachusetts
Date
To the Building Inspector: `/
The undersigned hereby applies for a permit to Zrect, ❑Alter, ❑Repair a sign on the following described buildings:
Street Address District
00'4' S(� I W(o`fD VJ S T ❑Urban Renewal Area ❑Entrance Corridor
❑Historic District ❑None
• E/z SC14 N - of Building
Telephone _ ?Yo _ floor
• M e—r S 2 floor
Address �jhl , 'AJ7- V floor
Telephone 78—S-O — aa3 4 floor
E-mail t n /i Ptel IznS How many businesses are in the building?
If a corporate body, name —;I-
of
responsible officerPVA E S pPtC
L S Z a U TC G R. Building linear feet
Catshrction Sups License No I$a(,(o t P Applicant's Space(if multi-tenant) yr linear feet
Address I (. W 6 LL8 S 7- Property linear feet
Telephone o )L3.�5 — Od-5--3y-030(v
E-mail --S I,•Vt VAC- S Iro Q). CCS I� ❑Sign Owner gn Erector ❑Other:
..o proposed attach @doit�cnai sheets)
Sign 1 Sign 2 Sign 3
V'Surfaoe p4brfaoe ❑Surface
❑Right Angle to Building ❑Right Angle to Building ❑Right Angle to Building
in Free Standing ❑Free Standing c Free Standing
❑Awning ❑Awning ❑Awning
❑Other(specify) ❑Other(specify) ❑Other(specify)
Sign Materials SignMaterials Sign Materials
G Urfa✓
Sign Dimensions Sign DimensioH Sign Dimensions
r
Sign AreaSign Area Sign Area
aa9Q, Fr o{ s ft FT O��QltiO�✓Js ft s ft
Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
$ 0D
Existing Signs EM
Type Sign Area To Bejno
Sign Owner
•Surface sq ft ❑
❑Right Angle to Building sq ft c
•Free Standing sq ft ❑ n Owners A oriz eprese five
❑Awning sq ft ❑❑Other(specify) sq R ❑
Property Owner
Internal Review
Planning&Community Development Department Historical Commission
Approval
Building In or
11/01/09 rev
City of Salem Department of Planning & Community Development
Check/Cash Receipt and Tracking Form
Please complete form and make two copies.
Date Received `
r
Amount Received
Form of Payment Check ❑ Cash
Client Information
CASH PAYMENTS: client initials
Sign Permit Application Fee
❑ Conservation Commission Fee
Payment received for what ❑ Planning Board Fee/ ZBA
service? ❑ SRA/DRB Fee
❑ Old Town Hall Rental Fee
❑ Other:
Name of staff person receiving
payment
Additional Notes r
A M E RS I G N EXPLANATION 3 O;
OPERATING ACCOUNT AMOUNT OO
16 DWELLEY ST.
PEMBROKE, MA 02359-1719 57017/211
PH, 781-826-72861g
PAY _
AMOUNT
OF GA�
DATE V DOLLARS 8' ii
TOT E ORDER OF
DESCRIPTION cHca
uuween
M0 � $ od
cmzexe exxx
MASSACHUSETTS19
qU -OFi2EL aGNATu��E
0003830/ 1: 2110 ?01754 130509282911'
Original Check and Form: DPCD Finance
Copy 1: Client
Copy 2: Application File